Provider Demographics
NPI:1912762717
Name:SMITH, MEGHAN ROSE MAREA (RBT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ROSE MAREA
Last Name:SMITH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34042 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-4356
Mailing Address - Country:US
Mailing Address - Phone:407-490-5898
Mailing Address - Fax:
Practice Address - Street 1:32 E MILLER ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3570
Practice Address - Country:US
Practice Address - Phone:407-683-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-316702106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician